to the editor: We would like to commend Dr. Rao on a timely review of the American Medical Association (AMA) Expert Committee's recommendations on childhood obesity.1 This article will raise physician awareness of a medical condition that has reached epidemic proportions. Although the article addresses screening across age groups and recommending interventions for patients older than two years, it does not offer advice for addressing obesity in children younger than two years. The literature on this population is sparse, but there are interventions that may help treat, delay, or eliminate the development of obesity in later life.

A 2007 review reported that “breastfeeding has a small protective effect on later obesity,” noting that breastfeeding for the prevention of obesity is recommended by the American Academy of Pediatrics (AAP).2 In addition, the group noted that most one-and two-year-old children consume sweet foods such as dessert, ice cream, and/or candy once daily, and that as many as 50 percent consume sweetened beverages every day.2 In contrast, the group notes that only one out of 10 children in this age group consume a dark green vegetable daily.2

One study reported that 75 percent of children zero to six years of age watched television for one hour a day and 32 percent watched videotapes/DVDs for an average of 20 minutes daily.3 The group also noted that of children zero to two years of age, one fifth had a television in their rooms, and 70 percent watched television, despite an AAP guideline that children younger than two years should not view any television.3 In the 2007 review, television viewing and a television in a child's room were associated with childhood obesity and overweight, respectively, among children one to five years of age.2

Interventions aimed at limiting screen time as well as promoting breastfeeding and appropriate dietary habits may have a large impact on limiting the number of children who eventually develop weight issues after two years of age. Early interventions may encourage further physician-patient interactions regarding childhood obesity and ultimately lead to better adherence to future weight reduction interventions, if needed. Given the potential for long-term benefits, it seems prudent to routinely ask parents and guardians of children younger than two years about television viewing and dietary habits to help prevent obesity.

The opinions and assertions contained herein are the views of the authors and are not to be construed as official or reflecting the views of the U.S. Army Medical Department or the U.S. Army service at large.

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